There are a variety of paths to practicing medicine, and an alternative route to the MD (Doctor of Medicine) degree offered by traditional “allopathic” medical schools is the DO (Doctor of Osteopathic) degree offered by “osteopathic” medical schools. Over recent years, there has been a boom in the number of osteopathic schools and graduates, largely stimulated by the shortage of primary care physicians. As a result of baby boomers becoming eligible for Medicare, combined with the increased patient population under the Affordable Care Act, the country is expected to face a shortage of 45,000 primary care doctors and 46,100 surgeons and specialists by 2020. 60% of DO-trained physicians enter primary care, compared to 30% of MD graduates.
A principal difference in the two approaches is that MD programs offer the traditional approach of Western medicine, whereas the DO philosophy is more holistic. DO medicine believes in the unity of the body, the impact of lifestyle and environmental factors on health, and the potential of the body to self-heal.
DO doctors practice primary care to a greater degree than MDs, including the specialties of internal medicine, family medicine and pediatrics, and help fill physician shortages in these fields. Many DO programs also have an added mission of providing doctors to underserved populations (poorer neighborhoods and towns that have doctor shortages). For example, Touro’s Osteopathic Program is located in Harlem.
How are DO and MD Doctors Similar?
- Attend 4-year medical school
- Complete specialty training through internships, residencies, and fellowships
- Require licenses from state medical specialty boards to practice
- Can practice in all 50 states in any specialty and provide all medical services
- May prescribe medications as appropriate
How are Osteopathic Students Unique?
- Trained to focus on the whole person, and consider lifestyle, environment, and psychological factors in treatment.
- Required to take up to 500 hours of additional classwork on osteopathic principles and aligning the musculoskeletal system.
- Learn the approach of Osteopathic Manipulative Treatment (OMT), which involves “using the hands to diagnose, treat, and prevent illness or injury.”
- Take the Comprehensive Medical Licensing Exam (COMLEX), whereas MD students take the United States Medical Licensing Exam (USMLE).
According to Steve Toplan, Director of Admissions at Touro College of Osteopathic Medicine, “The biggest difference [between MD and DO programs] is the fact that in the OM realm, students are taught osteopathic muscle manipulation (OMM). Other than that, the medical school curriculum is virtually the same.”
Interestingly, while OMM is the big differentiator between MD and DO training, “only 5% of DOs use hands-on techniques; mostly it’s in their heads in terms of the philosophy of how the body fully integrates,” said Brooke Birdsong, Associate Director of Admissions at Kansas City College of Osteopathic Medicine,.
Why Pursue a DO Degree?
There are several reasons why students may choose to pursue a DO degree.
Some students may feel that the holistic philosophy is more aligned with their values regarding medical care. Dr. Jennifer Caudle, DO and Associate Professor at Rowan University School of Osteopathic Medicine, says that she was drawn to its “mind-body-spirit whole-body approach to medicine.” In addition, she felt that historically DO schools were more open to non-traditional applicants, as well as a more diverse pool, noting that “DOs were some of the earliest institutions that accepted women and people of color.”
Others are drawn to the “hands-on” osteopathic manipulation approach. David Abend, DO, has had his own private practice for almost a decade. He began in primary care and now exclusively practices OMM because “I enjoy using my hands.” He treats a variety of physical ailments beyond neck and back pain, which is the traditional application. He also treats “arthritis, headaches, fibromyalgia, babies born with misshapen heads, patients with CP, Down Palsy, even reflux.”
Finally, DO programs are typically less selective than MD programs, so students who are not as competitive a candidate for MD admissions in terms of GPA and MCAT scores, or extracurricular activities, may benefit from the higher admit rate of most DO programs.
For example, Ben Kramer, a DO student at New York Institute of Technology College of Osteopathic Medicine, was always motivated to become a doctor, but did not realize how important it was to pursue medically-related activities during college, such as research, in order to be a competitive MD applicant. He spent the year after college as a scribe in the Emergency Department of a hospital, which provided patient contact and shadowing. He is now thriving at NYIT, and seeks to become a cardio-thoracic surgeon.
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Finally, cost may be another factor to consider. For the 2017-2018 school year, the majority of private medical schools charged more than $50,000 in tuition and fees (U.S. News). In contrast, 7 of the 10 least expensive private medical schools are osteopathic schools.
What is the Availability of DO Medical Colleges?
There has been a significant increase in the numbers of osteopathic medical colleges (from 5 in 1968 to 34 in 2018), as well as the numbers of osteopathic graduates (increasing from 971 in 1978 to 6,015 in 2017). This compares with 141 accredited MD schools and 89,904 MD graduates in 2017. For example, New York State has two osteopathic medical colleges: New York Institute of Technology and Touro, compared with 14 allopathic medical schools, including Columbia, NYU, and Weil Cornell.
Changes Ahead in Residency Matching
After graduating from medical school (either with an MD or DO degree), the next step in medical education is to participate in a residency program to obtain clinical experience. The process of applying for a spot occurs through a “matching” system in which students and programs rank each other, and are then matched by an algorithm. Up until now, there have been two separate processes for MDs and DOs.
DO students have the option of participating in the AOA Match (matching program for osteopathic students), the NRMP Match (National Resident Matching Program for allopathic students), or both matches. The AOA Match takes place earlier than the NRMP Match, which currently can create a dilemma for students who wish to participate in both.
But in 2014, the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), and American Association of Colleges of Osteopathic Medicine (AACOM) announced that they would create a single graduate medical education accreditation system that would integrate all allopathic and osteopathic residencies under a single authority by 2020. Once finished, it will streamline applying to all residencies for DO applicants.
According to Thomas J. Mohr, MS, DO, trustee for the Association of Osteopathic Directors and Medical Educators (AODME), “If your top choice is in the NRMP Match and your next three choices are in the AOA Match, you have a bit of a dilemma. If you match with an AOA program, you will be removed from the NRMP and have no shot at your top choice. But, if you don’t enter the AOA Match and don’t get your top choice in the NRMP, you have lost the opportunity for your back-up selection. This will no longer be an issue once all programs have transitioned to the ACGME.”
The participation of DO students in the NRMP residency match program has increased by 68.6% from 2014 to 2018. In 2016, 99.61% of DO graduates seeking graduate medical education (GME) achieved a residency position. 4.33% attained a Military Match, 48.97% received an AOA Match, and 45.84% were awarded an NRMP Match.
Which Path is Best for You?
It all depends! If you are passionate about primary care and think the osteopathic approach to medicine could be an asset to your education, a DO program could be the right fit for you.
According to Alan Stricoff, DO FACP, Cigna Medical Director for Onsite Health, “If want to become a highly competitive specialist, like an ophthalmologist, dermatologist, or specialty surgeon, the path is easier from a good MD program. However, if you are interested in primary care, there is no difference, and you may even be better off coming from a DO program, because of the focus on primary care.”
Navigating the many tracks to medical school can be daunting, but here at Collegiate Gateway, we are happy to help you in finding the best path to reaching your goals. Feel free to contact us!